2009–10

SDCMS

2009–2010 Annual Report “Physicians United for a Healthy San Diego”

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Health REFORM

SDCMS and CMA were engaged at all levels of health reform throughout 2009 and into 2010, ensuring bills were amended to account for California’s socioeconomic differences, health status differences, and geographic differences in practice costs. Had the rural states prevailed — i.e., had CMA not fought this fight — California’s physicians would have received up to 22% in payment cuts! SDCMS and CMA did an incredible job throughout the health reform process as well of educating San Diego County’s and California’s congressional delegations, particularly those House Democratic leaders that included $450 billion in physician payment fixes in the House bill to provide coverage and access to doctors. Though CMA should have been stronger in its opposition to the Senate bill, we did get commitments from the White House and House and Senate leaders to address physician payment issues, to stop the 21% SGR cut and repeal the SGR payment formula, and to weaken the impact of the Medicare Independent Payment Advisory Board (IPAB) on physicians.

CMA is working on these issues and continues to fight to pass a California fix.

What Did CMA Enable?

» 85% of health plan revenues directed to patient care. » Adequate health plan provider networks. » Affordable, universal access to care for low-income, uninsured Californians. » Two-thirds of low-income, uninsured Californians going into private coverage instead of Medicaid. » Medicaid rates for primary care physicians increased to Medicare levels. » 100% federally funded Medicaid expansion and rate increase. » State-based health insurance exchanges instead of one national exchange. » Increased Medicare rates for all physicians to bolster primary care in California. » Additional Medicare payment increase for primary care physicians. » Patient right to seek care from the physician of their choice outside of health plan networks. » Quality reporting program physician information protected and accurate, physician data statistically valid, attribution methodology correct, information risk-adjusted, physician right to review data before it is finalized or made public. » Appropriate CMS systems to produce accurate physician information for quality reporting programs. » Physician accountable care organizations not to need to include a hospital. » Current, unused residency slots redistributed for primary care and general surgery. » Uniform Medicare prescription drug appeals form and process.

What Did CMA Prevent?

Health Reform’s Unfinished Business for 2010: ✓ Stop the 21% Medicare cut and repeal the Medicare SGR. ✓ Eliminate the Medicare Independent Payment Advisory Board. ✓ Update California’s geographic payment localities (GPCI). ✓ Increase Medicaid rates for all physician specialties. ✓ Improve the quality reporting programs. ✓ Prevent additional physician liability exposure. ✓ Allow patients to privately contract with physicians.

» Insurance companies from rescinding insurance when a patient becomes ill. » A public option that would have mandated physician participation and paid Medicare rates. » The implementation of a “value index” payment system that would have reduced payments to California physicians by up to 15%. » The reduction of Medicare payments in California for geographic practice costs by up to 8%. » A provision that would have allowed nurse practitioners to lead medical homes. » A provision that would have banned existing physician-owned hospitals. » A 5% Medicare penalty on physician utilization outliers. » A $350 Medicare participation fee for doctors. » CMA worked with AMA to push back the penalties for nonparticipation in Medicare’s Physician Quality Reporting Initiative (PQRI) until 2014. » A cosmetic surgery tax. » CMA joined the chorus in opposition to the Cadillac health plan tax on high-end benefits because it disproportionately harms California’s employers and individual purchasing insurance. The tax was delayed until 2018. » CMA fought to eliminate the Medicare Advantage private, fee-for-service plans by equalizing Medicare Advantage payments with Medicare private, fee-for-service payments. Medicare Advantage plan rates will be cut by $130 billion; however, plans that meet certain quality standards may qualify for bonuses.

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Political/

Legal/ Reimbursement

Reimbursement

Advocacy

CMA SPONSORED LEGISLATION THAT:

»» Gives osteopathic physicians access to the Steve Thompson Loan Repayment Program — signed by the governor. [SB 606] »» Would have protected patients from having their insurance policies rescinded — passed by the Assembly and Senate but vetoed by the governor. [AB 2] »» Would have strengthened the current peer review system — passed by the Assembly and Senate but vetoed by the governor. [AB 120]

CMA KILLED LEGISLATION THAT:

» Would have allowed virtually all healthcare districts and rural hospitals to directly employ up to five physicians. [SB 726] » Would have allowed healthcare districts located in underserved areas to directly employ and charge for physician services. [AB 646] » Would have allowed rural hospitals that serve underserved areas or populations to directly employ and charge for physician services. [AB 648] » Would have allowed physical therapists to evaluate and treat patients without a previous diagnosis or referral from a licensed physician. [AB 721] » Would have circumvented MBC’s fair hearing process by not allowing a physician to test the validity of charges prior to an 805 report’s being filed. [SB 700]

CMA GUTTED LEGISLATION THAT:

»» Would have required all physicianowned surgical clinics to be licensed by the state. [AB 832] »» Would have allowed pharmacists to independently initiate and administer immunizations to children and adults. [AB 977] »» Would have allowed nurse practitioners to admit patients and to be designated primary care providers.

[SB 294]

CMA PREVENTED LAWMAKERS FROM TAKING MORE THAN $100 MILLION FROM CALIFORNIA’S MEDI-CAL PHYSICIAN PROVIDERS IN 2008 AND 2009 CMA STRONGLY OPPOSED LEGISLATION — AB 542: “Nonpayment for Adverse Events” — AND CONVINCED ITS AUTHOR TO DRAMATICALLY NARROW ITS SCOPE TO APPLY ONLY TO HOSPITALS

CMA BACKED LEGISLATION THAT:

» Draws down federal funds to help fund the Healthy Families Program — signed by the governor. [AB 1422] » Would require the DHCS to improve and streamline the Medi-Cal treatment authorization request process. [AB 613] » Would require the performance of an occupational analysis on any bill seeking to substantively expand the scope of a healing arts practice. [AB 877]

SDCMS worked to enroll physicians in the California Health Alert Network (CAHAN) as it transitioned from the San Diego County Emergency Medical Alert Network (EMAN)

SDCMS AND CMA CONTINUED TO FIGHT HEALTH PLAN AND GOVERNMENT MALFEASANCE:

»» By suing WellPoint for colluding with Ingenix on a price-fixing scheme. »» By getting the California DOI to sue PacifiCare for widespread and unfair payment processes in the wake of United Healthcare’s takeover of PacifiCare in 2005. »» By publishing a Blue Cross tool kit to help physicians understand the impact all of Anthem Blue Cross’ 2009 changes would have on their practices. »» By co-signing a letter with UCSD to our congressional delegation strongly opposing the elimination of the CPT codes for consults. »» By hosting live webinars and developing a written toolkit to help members understand and comply with the “Red Flags Rule.”

SDCMS AND CMA FOUGHT FAULTY QUALITY REPORTING INITIATIVES: CMA APPEALED TO THE U.S. COURT OF APPEALS TO REINSTATE THE INCORRECTLY REJECTED STANDING OF ITS GPCI LAWSUIT IN 2009

MADDY FUNDS CONTINUE TO FLOW TO ER PHYSICIANS In 2009, Maddy Fund disbursements, which go to hospitals and physicians providing uncompensated trauma care, came to more than $4,250,000. Recall that an additional funding source for the Maddy Fund was procured in 2007 with SDCMS’ support.

» By urging physicians to request their data from the California Physician Performance Initiative (CPPI) to verify its accuracy. » By requesting that the California Cooperative Healthcare Reporting Initiative (CCHRI) not publish the faulty and misleading 2009 CPPI results. » By withdrawing from the Blue Shield-led initiative when the CCHRI didn’t correct the deficiencies CMA raised before moving forward in 2010.

MEDICAL

»» CMA reached out to all the major payers in California for clarification on their H1N1 billing policies and compiled the information into an easy-toread members-only chart. »» SDCMS was heavily involved in the redistribution of vaccines from San Diego County’s hospitals to physician practices. »» SDCMS worked with the County of San Diego and others to record a series of “quick and easy” H1N1 videos for physicians and office staff: • “Pandemic H1N1 Influenza Vaccine” • “H1N1 Epidemiology” • “Laboratory Diagnosis of Influenza During the H1N1 Pandemic” • “Use of the Pandemic H1N1 Vaccine for Fall 2009” • “Pandemic 2009 H1N1 Influenza: Treatment in Adults” • “H1N1 Pandemica Influenza: Treatment of Infants and Children” »» SDCMS collected resources from as many authoritative HIN1 sources as possible and made them available to members at SDCMS.org.

CMA FENDED OFF A TRIAL LAWYER ATTACK ON MICRA IN 2009

when the 5th District Court of Appeal unanimously upheld its constitutionality, thereby keeping your professional liability insurance premiums reasonable. SDCMS continued in 2009 and continues today to interview all candidates for San Diego County legislative offices in order to ensure they understand the paramount importance MICRA holds for California’s physicians.

PALMETTO

» SDCMS and CMA continued in 2009 to help member physicians — many who hadn’t been paid in months — get their issues resolved by putting their problems directly into the hands of our contacts at Palmetto. » SDCMS invited a Palmetto representative to give two three-hour post-transition seminars for members and their staff. » Thanks to CMA advocacy, Palmetto GBA agreed to repeal its overly restrictive “monitored anesthesia care” policy.

Cma, Sdcms, And Others Lobbied Both Houses Of Congress To Submit Bills To Fix The Gpci In 2009, Which Decreases San Diego County Physician Payments From $30 To $100 Million Annually

CMA FORCED HEALTH PLANS, REGULATORS, AND OTHERS:

»» To clarify new prepayment review requirements documentation. [Health Net] »» To agree to automatically reprocess all affected claims after it delayed loading new 2009 CPT codes into its claims payment system. [Blue Shield] »» To remove a number of problematic provisions in a proposed contract. [Blue Cross] »» To allow physicians to opt out of its paperless EOB program.

[Blue Cross] »» To allow physicians with Prudent Buyer contracts to continue to treat Blue Cross Healthy Families patients through the end of October 2009. [Blue Cross] »» To clarify how physicians would be paid for vaccines under its new contract. [Blue Cross] »» Not to allow chiropractors to perform manipulation under anesthesia. »» Not to expand the scope of practice of psychologists and potentially all other healthcare facility healthcare practitioners. »» To expedite the MBC review process of resident physician and other medical license applicants with time-specific needs. »» To stop the transfer of $6 million from the MBC’s Contingent Fund to the state’s General Fund. »» To stop the imposing of three furlough days per month on the MBC. »» To postpone (after vociferous objections from CMA and others) the “Red Flags Rule” deadline from May 1 to Aug. 1 to Nov. 1, 2009, and then to June 1, 2010.

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Political/

Legal/ Reimbursement

Reimbursement

Advocacy

PHYSICIAN WORKFORCE MONITORED

»» In 2009, we conducted our fourth San Diego County Physician Workforce and Compensation Survey — alone in San Diego County and across California in monitoring our physician workforce in order to ensure physician shortages, whether actual or projected, can be identified before they result in access-to-care crises.

SDCMS’ physician workforce surveys are critical tools in our discussions with lawmakers and decision makers.

Engaging Physicians

» SDCMS held young-physicians socials in May and August, with more than 50 young physicians and residents attending each. » SDCMS’ 2009 Installation Dinner and Dance brought together more than 230 physicians, guests, healthcare leaders, other VIPs, and eight of our 13 state legislators — our largest event in seven years. » More than 450 physicians and guests attended the 2009 “Top Doctors” gala. » SDCMS convened quarterly chiefs of staff meetings. » SDCMS took five senior physician leaders to Washington, DC, in March to meet with each of our congressional representatives. » SDCMS took eight medical student members to Sacramento to meet with all of our San Diego County state legislators. » SDCMS went to Sacramento in April to meet with each of our San Diego County state legislators. » SDCMS held two past-presidents dinners. » SDCMS participated in UC San Diego’s Student Fair in June and signed up 120 new medical student members. » SDCMS attended 22 general staff and medical executive committee meetings at hospitals throughout the county.

Engaging

Our Physician

Members

Communicating

to, for, and From Our

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Members

»» CMA’s Ethnic Physician Organization Section implemented a mentoring program where second- and thirdyear medical students are paired for one year with compatible physicians who practice in their city. »» Created under a CMA-sponsored law in 2020, the Steven M. Thompson Physician Corps Loan Repayment Program continued in 2009 to offer physicians medical school loan repayment grants of up to $105,000 in exchange for a three-year service commitment in a medically underserved area of the state.

SDCMS Website

We launched our new website at the end of 2008 and continued to expand our membersonly online resources to include the ability to: » build your own website » post and manage your own classified ads » view previously recorded seminars and webinars » consult our growing FAQ database with answers to hundreds of your practice management questions » renew your membership online » manage your profile » and much more …

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Physician Communications »» San Diego Physician magazine continued to give voice to San Diego County’s physician community in 2009, reaching 8,500-plus subscribers monthly. »» Our biweekly “News You Can Use” e-newsletter continued to keep its 4,000-plus recipients abreast of information critical to maintaining successful physician practices. »» San Diego County’s print and broadcast news media continued to turn to SDCMS first when seeking the opinion of San Diego County’s physicians.

SDCMS Membership Grew to 2,578 in 2009

SDCMS is now the second-largest CMA component medical society, after the Los Angeles County Medical Association.

members

3000

2,562 2,578 2,390 2,419 2,029 2,056 2,163 2,195

2000

2002 2003 2004 2005 2006 2007 2008 2009

Member Benefits » Your SDCMS physician advocate and office manager advocate resolved more than 400 member and member office staff issues, including economic advocacy issues, legal issues, and member benefits requests. » Your SDCMS-endorsed partner, The Doctors Company, saved you from hundreds to thousands of dollars with its 5% discount on insurance premiums and 7.5% dividend credit. » SDCMS members (only) were listed in San Diego Magazine’s May 2009 “Health Annex” supplement. » For the fifth straight year — while continuing to improve the selection process — SDCMS partnered with San Diego Magazine in 2009 to select San Diego County’s “Top Doctors: Physicians of Exceptional Excellence.” » SDCMS continued to invite you and your staff to attend our seminars virtually via our 3000 webinar technology. » SDCMS created an “E-prescribing for Dummies” presentation. » SDCMS partnered with Strategic HR to give our members and their office staff a complete range of HR solutions, including free answers to your difficult HR questions. » As we do every year, SDCMS 2500 2,578 2,562partnered with RCL Portrait Design to take your photos for our directory and website free of charge.

2,419 » SDCMS made available to you and your staff 2,390 a treasure trove of answers to your practice management questions via our online FAQ search tool.

2,195

2,163

2000

2,056

SDCMS Revenues and Expenses 1500

SDCMS Fiscal Year 2008-2009

Labor and Cash Expenses Physician Engagement Governance 6% 13% Physician Database 4% Communication 1000 25%

Benefits

13% 500

SDCMS Income 2008-2009 Rent 10%

Advertising & Sales 16%

Accounting 1% Consumables 1% Copier 1%

Infrastructure 31%

Credit Card/ Bank Charges 1% Insurance 2% Misc. Expense 3% Postage 1% Telephone 1%

Dues 62%

Investments 14%

Staff time G&A 8%

Advocacy Specialty Foundation 6% 2% Societies 1%

Misc 3%

AMA/CMA Commission Sponsorships 4% 1%

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membership and

operations

KEEPING YOU AND YOUR STAFF TRAINED AND INFORMED In 2009, SDCMS conducted 26 seminars and 25 webinars with 185 members and 575 of their office staff attending, with topics including “Palmetto Post-transition,” “Top 10 Collections Procedures,” “E-prescribing for Dummies,” “How to Attract and Keep the Best Patients,” “Health Plan Contracting Savvy,” “Coding to Optimize Compliance and Reimbursement,” “Human Resources Essentials,” “The Patient-centered Medical Home,” “Preparing to Practice,” “What the Health Is Happening in Washington and Sacramento?” “EMR Trunk Shows,” “Leader’s Toolbox,” “The Perils and Pitfalls of Business Relationships With Nonphysicians,” “Employment Law 101,” “A Step-by-step Guide to Maximizing Your Cash Flow,” “OSHA Updates,” “Health Reform Townhalls,” “How to Successfully Select and Implement an EMR,” “HIPAA and HITECH Updates,” “10 Strategies for Economic Survival,” “Become a Certified Medical Coder,” “POLST Training for Physicians,” “Electronic Medical Records: Are You Ready?” and more.

Technology » SDCMS held two “EMR Trunk Shows” in 2,029 2009 to allow members and their staff to see the major EMR/EHRs in operation, to meet the sales staff, and to learn how to choose an EMR. » SDCMS created a members-only “E-prescribing for Dummies” presentation to detail the pros and cons of e-prescribing, to explain how to receive Medicare’s 2% e-prescribing incentive, and to give a vendor-neutral overview of some e-prescribing products. » CMA created an HIT resource center online.

Connecting Patients With Donated Healthcare Services

SDCMS foundation

2009 Annual Report Our Mission:

“addressing unmet San Diego health care needs for all patients and physicians through innovation, education and service”

SDCMSF’s Project Access San Diego (PASD) coordinates private physician volunteer care by providing patient navigation and referral management services. In 2009 PASD recruited 300 physicians in 18 specialties to see medically underserved patients for free.

Eighty-six percent of PASD patients fell below 150% of the federal poverty level, earning less than $35,000 per year for a family of four. Our PASD partners in 2009 included: Alliance Healthcare Foundation • Anesthesiology Services Medical Group • California Endowment • County of San Diego • Grossmont Healthcare District • Imaging Healthcare Specialists • Kaiser Permanente • San Diego Pathology Group • Supervisor Greg Cox • Supervisor Ron Roberts • Valley Radiology • The WebMD Foundation • UCSD Medical Center • And Many Others …

Your SDCMS Foundation in the Spotlight SDCMSF was invited to present our innovative models of caring for the medically underserved in our community on the national stage in 2009. The County of San Diego, led by Supervisor Ron Roberts, recognized SDCMSF with a proclamation that June 16, 2009, was “San Diego County Medical Society Foundation Day,” in honor of our service to the community. Assemblywoman Lori Saldaña also recognized SDCMSF’s efforts to support the needs of the safety net. In 2009, nonprofit leader Guidestar awarded SDCMSF with a preferred partner seal and a premium presence on its donor-driven website (22,000 visitors every day).

Optimizing Specialty Care Resources in the Community SDCMSF’s new Specialty Care Access Initiative partnership with the Council of Community Clinics is increasing access to specialists at the clinic level by recruiting physicians to volunteer at health centers and by hosting specialty roundtables at SDCMS to promote referral efficiency and new referral guidelines for practicing primary care providers. E-consults are in the works for 2010.

SDCMSF Financial Snapshot FY09 Assets: »» Cash: $166,254 »» Investments: $504,808 »» Accounts Receivable: $53,928 »» Note Receivable: $48,411 »» Equipment Net: $630 »» TOTAL: $774,031 Income Summary: »» Grants: $601,712 »» Contributions: $63,769 »» In-kind Contributions (SDCMS): $39,135 »» Miscellaneous (bad debt recovery): $20,934 »» Investment Income (includes losses): $5,629 »» TOTAL: $731,179 Activities Summary: »» Programs: $584,672 »» Fundraising: $8,258 »» Administrative: $50,216 »» TOTAL: $643,146

Your SDCMS Foundation in the Headlines

SDCMSF hit the headlines in 2009. We were featured in the San Diego Business Journal, on Fox News, on Channel 10 News, on Channel 7 & 39 News, online at Yahoo!

News and at CNBC, with coverage on service to safety net patients through PASD and Surgery Days.

SDCMSF Financial Review Governance and Oversight »» The Foundation maintained focus on strong governance and oversight and implemented several new financial policies in FY09, including an investment policy and a conflict of interest policy. »» The Foundation received an unqualified opinion from the public accounting firm Leaf & Cole, LLP, concluding another successful audit.

SDCMSF Staff (l–r): Lauren Radano, Barbara Rodriguez, Kitty Bailey, Tana Lorah, Alisha Mann, and Brenda Salcedo

Protecting Volunteer Physicians From Medical Liability Medical liability protection for volunteer physicians is on the radar screen of California’s legislators. SDCMSF worked to support a partnership between CMA and the Medical Board of California to introduce new legislation that will cover physicians who volunteer in California. Watch for developments in 2010.

Supporting Future Physicians In 2009, SDCMSF supported future physicians through scholarships for UC San Diego School of Medicine students Ruben Carmona, Tuan Van Mia, and Colin Zimmerman. We look forward to seeing the future accomplishments of all of our scholarship winners who all demonstrated an outstanding commitment to our community.

And Helping Patients Achieve Wellness

Through Project Access San Diego, more than $800,000 in donated care was provided in 2009, making a significant impact in achieving better health for patients by lowering symptomatic days, by reducing the number of missed days of work, and by reducing the number of clinic and emergency department visits. » 4 Surgery Days » $800,000 in Donated Services » 600 Volunteers » 160 Lives Changed » 3 Lives Saved

Operating Budget »» Operating income increased in 2009 by 58% over the prior year, as the Foundation increased revenues and expenses to accommodate five new staff persons to support three programs. »» SDCMSF closed the budget year with a balanced budget.

Investment Review »» Through extreme turmoil in the financial markets, the Foundation adopted an investment policy to protect the corpus of investments and maintained a disciplined approach to asset allocation and management of the investments. »» Risk was reduced by employing a conservative reinvestment policy and shifting investments to U.S. Treasury Securities. Investments are reviewed monthly and approved by the board of directors.